The Surgical Management of Bilateral Carotid Artery Occlusive Disease
Fifty percent of our patients undergoing EC-IC bypass surgery have been found to have.bilateral carotid artery occlusive disease. The purpose of this paper is to analyze this small number of patients to see if a logical sequence of surgical therapy can be arrived at. A similar series of patients was reported by Moran et al.4 It was their recommendation that in patients with a symptomatic unilateral carotid occlusion and a contralateral carotid stenosis a STA-MCA bypass should be done first on the occluded side. Then a prophylactic carotid endarterectomy could be performed on the other side. Some surgeons might disagree with this sequence by arguing that a carotid endarterectomy done first might alleviate the symptoms on the occluded side, via collateral flow through the anterior communicating artery. If this were the case, then only one operation would be necessary, i.e., the ischemic symptoms on the occluded side would be alleviated and the brain on the stenotic side would be prophylactically protected.
KeywordsIschemia Lution Reso Aphasia
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